Prosthetic device, method of planning bone removal for implantation of prosthetic device, and robotic system

ABSTRACT

A prosthetic device, method for planning bone removal, and a robotic system for implantation of a prosthetic device in bone are disclosed. The prosthetic device can include a body portion for attachment to a bone, wherein the body portion includes an implantation surface configured to face the bone upon implantation, and a constraint structure. The prosthetic device, method, and robotic system can be configured to cause the constraint structure and bone to interact so as to constrain the prosthetic device in the bone.

CROSS-REFERENCE TO RELATED PATENT APPLICATIONS

This application claims priority to U.S. Provisional Patent ApplicationSer. No. 61/208,451, filed on Feb. 24, 2009, which is herebyincorporated by reference in its entirety.

BACKGROUND OF THE INVENTION

1. Field of Invention

The present invention relates to a prosthetic device for implantation inbone, methods of planning bone removal for implantation of a prostheticdevice in bone, and robotic systems for preparing a bone to receive aprosthetic device.

2. Description of Related Art

Conventional prosthetic implantation techniques involve resecting apocket of material from a bone to provide a void or pocket within thebone that receives a prosthetic device. After resection of bone materialis complete, the prosthetic device is implanted within the pocket. Theprosthetic device is typically secured in place with bone cement.

Using the conventional techniques, undesired movement of the prostheticdevice relative to the bone may occur. In particular, the pocket in thebone often includes an expansion gap that provides empty space betweenthe prosthetic device and the remaining bone. This expansion gap may befilled or partially filled with bone cement during implantation of theprosthetic device to permit uniform or near uniform dispersion of thebone cement. FIG. 34 shows a top view of an example of a conventionalprosthetic device 10 implanted in a medial condyle 12 of a tibia (thelateral condyle 14 is shown for reference). An expansion gap 16 isprovided between the prosthetic device 10 and an edge of the remainingbone in the medial condyle. The expansion gap, which is typically0.5-0.8 mm in a tibia, is exaggerated in this drawing for purposes ofillustration. This expansion gap may cause the prosthetic device to beless than fully constrained, which can permit unwanted movement of theprosthetic device. Consequently, the prosthetic device may move (e.g.,rotate or translate) relative to the bone when a force is applied to theprosthetic device. For example, during trial articulation of a leg,contact forces from a femoral condyle can cause unwanted movement of atibial inlay. In addition, undesired movement can occur during finalfixation as a surgeon presses against the prosthetic device to dispersethe bone cement and squeeze out excess bone cement.

Using conventional techniques, it also may be undesirably difficult toproperly position a prosthetic device in the pocket in the bone. Forexample, there can be difficulty in positioning the cup of a hipacetabulum in a desired tilt/abduction and anteversion due to difficultyin knowing exactly where a pelvis is located during total hiparthroplasty.

SUMMARY

An embodiment relates to prosthetic device for implantation in bone. Theprosthetic device includes a body portion for attachment to a bone,wherein the body portion includes an implantation surface configured toface the bone upon implantation. The prosthetic device further includesconstraint structure comprising at least one of: (i) at least onecompressive projection projecting from the implantation surface in alateral direction of the body portion and configured to provide acompressive force between the at least one compressive projection andthe bone, (ii) at least one interlock projection projecting from theimplantation surface and having an interlock-projection surfaceconfigured to receive bone in a space between the interlock-projectionsurface and a proximal portion of the implantation surface, and (iii) atleast one recess in the implantation surface and configured to receivebone to constrain the body portion in at least two translational degreesof freedom. The constraint structure is configured to constrain theprosthetic device in the bone.

Another embodiment relates to a method for planning bone removal forimplantation of a prosthetic device into bone. The method includesstoring data representative of a prosthetic device in a computerreadable medium, wherein the prosthetic device includes a body portionhaving an implantation surface configured to face the bone uponimplantation and at least one feature that provides a constraintstructure that will constrain the prosthetic device in the bone. Themethod further includes defining, based on the data, at least onebone-cutting pattern for (i) removing a first portion of bone in a firstarea sufficient to seat the body portion and (ii) at least one ofremoving and maintaining a second portion of bone in a second areaconfigured to interact with the constraint structure.

Yet another embodiment relates to a robotic system for preparing a boneto receive a prosthetic device. The robotic system includes acontrollable guide structure configured to guide cutting of the boneinto a shape for receiving the prosthetic device. The robotic systemfurther includes a computer readable medium for storing datarepresentative of the prosthetic device, wherein the prosthetic deviceincludes a body portion having an implantation surface configured toface the bone upon implantation and at least one feature that provides aconstraint structure that will constrain the prosthetic device in thebone. The robotic system further includes a control system forcontrolling the guide structure, wherein the control system isconfigured to define at least one bone-cutting pattern for (i) removinga first portion of bone in a first area sufficient to seat the bodyportion and (ii) at least one of removing and maintaining a secondportion of bone in a second area configured to interact with theconstraint structure.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated and constitute a partof this specification, illustrate embodiments of the invention andtogether with the description serve to explain aspects of the invention.

FIG. 1 is a perspective view of a prosthetic device implanted in apocket in a tibia, according to an embodiment.

FIG. 2 a is a top view of a representation of the pocket and zones whereprojections are to be provided in bone, according to an embodiment.

FIG. 2 b is a top view of a representation of areas of bone forresection.

FIG. 2 c is a top view of a bone cutting pattern, according to anembodiment.

FIG. 2 d is a top view of a portion of the tibia of FIG. 1 showing thepocket resected according to the bone cutting pattern of FIG. 2 c.

FIG. 2 e is a top view of the tibia of FIG. 1 with the prosthetic devicein the pocket.

FIG. 3 a is a top view of a portion of a tibia showing an intendedpocket with three projections, according to an embodiment.

FIG. 3 b is a top view of the tibia of FIG. 3 a, showing the pocketwithout the prosthetic device.

FIG. 3 c is a top view of the tibia of FIG. 3 a with the prostheticdevice in the pocket.

FIG. 4 is a perspective view of a tibia having a pocket with verticallyoriented projections, according to an embodiment.

FIG. 5 a is a perspective view of a circumferential perimeter of apocket, according to an embodiment.

FIG. 5 b is a perspective view of a tibia having the pocket of FIG. 5 a.

FIG. 5 c is a perspective view of a pocket, according to an embodiment.

FIG. 5 d is a perspective view of the circumferential perimeter of thepocket of FIG. 5 c.

FIG. 6 a shows a perspective view of an exemplary projection, accordingto an embodiment.

FIG. 6 b is a top view of the projection of FIG. 6 a.

FIG. 6 c is a side view of the projection of FIG. 6 a.

FIG. 6 d is a front view of the projection of FIG. 6 a.

FIG. 7 a is a side cross-sectional view of a projection extending onlypartially along a vertical depth of a pocket, according to anembodiment.

FIG. 7 b is a side cross-sectional view of a projection extending 100%of a vertical depth of a pocket, according to an embodiment.

FIG. 8 a is a side cross-sectional view showing an interference fitbetween a prosthetic device and a projection of a bone, according to anembodiment.

FIG. 8 b is a side cross-sectional view showing an interference distancefor an interference fit between a prosthetic device and a projection ofa bone, according to an embodiment.

FIG. 9 is a perspective view of a tibia with a horizontally orientedprojection, according to an embodiment.

FIG. 10 is a side cross sectional view of a femur with a prostheticdevice in a pocket, according to an embodiment.

FIG. 11 a is a top cross sectional view along line A-A of FIG. 10.

FIG. 11 b is a top cross sectional view along line B-B of FIG. 10.

FIG. 12 a is a side cross-sectional view of a prosthetic device in afirst stage of implantation, according to an embodiment.

FIG. 12 b is a side cross-sectional view of the prosthetic device ofFIG. 12 a in an advanced stage of implantation.

FIG. 12 c is a side cross-sectional view of the prosthetic device ofFIG. 12 a when implanted.

FIG. 13 is a perspective view of a prosthetic device, according to anembodiment.

FIG. 14 is a side view of the prosthetic device of FIG. 13.

FIG. 15 is a bottom view of the prosthetic device of FIG. 13.

FIG. 16 a is a side cross-sectional view of a prosthetic device in afirst stage of implantation, according to an embodiment.

FIG. 16 b is a side cross-sectional view of the prosthetic device ofFIG. 16 a in an advanced stage of implantation.

FIG. 16 c is a side cross-sectional view of the prosthetic device ofFIG. 16 a when implanted.

FIG. 17 a is a top view of a bone with projections for projecting intorecesses of a prosthetic device, according to an embodiment.

FIG. 17 b is a cross sectional view taken along line A-A in FIG. 17 awith a prosthetic device implanted in the pocket.

FIG. 18 a is a top view of a alternative prosthetic device thatimplanted in pocket of the prepared bone of FIG. 17 a, according to anembodiment.

FIG. 18 b is a cross sectional view taken along line B-B in FIG. 18 a.

FIG. 19 a is a top exploded view of a prosthetic device with recessesand bone projections, according to an embodiment.

FIG. 19 b is a cross sectional view taken along line B-B in FIG. 19 a,with the prosthetic device implanted.

FIG. 20 is a cross-sectional view of the prosthetic device of FIG. 19 a.

FIG. 21 a is an isometric view of a femur with a pocket having aprojection, according to an embodiment.

FIG. 21 b is a side cross sectional view of the femur of FIG. 21 a.

FIG. 22 is a perspective view of a prosthetic device for implanting inthe pocket of FIG. 21 a.

FIG. 23 a is a cross sectional view of a hip bone with a pocket preparedto receive a prosthetic device, according to an embodiment.

FIG. 23 b is a cross sectional view of the hip bone of FIG. 23 a as aprosthetic device is being inserted into the hip bone.

FIG. 23 c is a cross sectional view of the hip bone of FIG. 23 a afterthe prosthetic device has been implanted into the hip bone.

FIG. 24 a is a top exploded view of a prosthetic device with projectionsand a bone with recesses, according to an embodiment.

FIG. 24 b is a cross sectional view taken along line C-C in FIG. 24 a,with the prosthetic device implanted.

FIG. 25 a is a top exploded view of a prosthetic device with projectionsand a bone with recesses, according to an embodiment.

FIG. 25 b is a cross sectional view taken along line A-A in FIG. 25 a,with the prosthetic device implanted.

FIG. 26 a is a side view of a prosthetic device, according to anembodiment.

FIG. 26 b is a top view of the prosthetic device of FIG. 26 a.

FIG. 27 is a top view of bone with a pocket and an implanted prostheticdevice that includes projections, according to an embodiment.

FIG. 28 a is an isometric view of bone having a projection on a bottomsurface of a pocket, according to an embodiment.

FIG. 28 b is an isometric view of bone having a projection on a bottomsurface of a pocket, according to an embodiment.

FIG. 28 c is an isometric view of bone having a plurality of projectionson a bottom surface of a pocket, according to an embodiment.

FIG. 29 a is a side view of a prosthetic device with projections,according to an embodiment.

FIG. 29 b is a side view of a prosthetic device with projections,according to an embodiment.

FIG. 30 is an isometric view of a robotic system, according to anembodiment.

FIG. 31 a is a progression of a bone that has experienced trauma andbeen repaired, according to an embodiment.

FIG. 31 b is a close up of a bone fracture that has been repaired,according to an embodiment.

FIG. 31 c is a view of various constraint structure geometries,according to an embodiment.

FIG. 32 a is an isometric view of a bone piece prepared to engage with ahardware component, according to an embodiment.

FIG. 32 b includes a top view and a cross sectional view of a hardwarecomponent, according to an embodiment.

FIG. 33 is a progression of a bone that has experienced trauma and beenrepaired with a component that serves as an additional bone piece,according to an embodiment.

FIG. 34 is a top view of a conventional prosthetic device implanted in atibia.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Presently preferred embodiments of the invention are illustrated in thedrawings. An effort has been made to use the same or like referencenumbers throughout the drawings to refer to the same or like parts.

Overview

The preferred embodiments relate, in general, to methods for planningbone removal to allow implantation of a prosthetic device to create aconstraining relationship between the bone and the prosthetic device.The preferred embodiments also relate to prosthetic devices that areconfigured to achieve such a constraining relationship and a roboticsystem that can be used to facilitate the creation of such aconstraining relationship.

In general, the methods for planning include storing data representativeof the prosthetic device in a computer readable medium. The methodsfurther include defining, based on the data, at least one bone-cuttingpattern for (i) removing a first portion of bone in a first areasufficient to seat a body portion of the prosthetic device and (ii) atleast one of removing and maintaining a second portion of bone in asecond area configured to interact with a constraint structure of theprosthetic device. The method also may include displaying informationrepresentative of the at least one bone-cutting pattern, for example ona conventional monitor. Particular implementations of the planningmethods are described below, though the invention is not limited tothose particular implementations.

Particular implementations of prosthetic devices and a robotic systemthat are useful with the planning methods also are described below.However, the invention is not limited to those particularimplementations and the prosthetic devices and robotic system could beused without the planning methods.

Creating Bone Projections that Provide Compressive Force to ProstheticDevice

One such implementation of the planning method includes defining thebone cutting pattern for removing a first portion of bone in the firstarea sufficient to seat a body portion of the prosthetic device and formaintaining a second portion of bone in the second area to provide atleast one projection of bone configured to engage an implantationsurface of the prosthetic device to provide a compressive force betweenthe projection and implantation surface and constrain the prostheticdevice. This compressive force need not be sufficient to deform theprojection or the implantation surface, though it may deform one orboth.

FIGS. 1 and 2 e show views of a prosthetic device 90, e.g., a tibialinlay, implanted in a pocket (or bone cavity) 106 formed by resectingbone from a tibia 100 pursuant to such a planning method. The prostheticdevice 90 preferably includes a body portion 91 and an implantationsurface 94 configured to face the bone of the tibia 100 uponimplantation. In this embodiment, the implantation surface 94 can form aconstraint structure 107 of the prosthetic device 90. The planningmethod provides bone projections 104 in the pocket 106 that engage theconstraint structure 107 to constrain the prosthetic device 90.

To achieve such a pocket 106 with projections 104, initially zones 109can be identified in which it is desired to locate the projections 104,as shown in FIG. 2 a. In this figure, the anterior A, posterior P,medial M, and lateral L directions are identified. Then, based on datarepresentative of the prosthetic device 90, a bone-cutting pattern isdefined for removing a first portion of bone in a first area 101 withinline 162 (see FIG. 2 b) sufficient to seat the body portion 91 of theprosthetic device 90. The bone-cutting pattern (or another bone cuttingpattern) is also defined to remove portions of bone in a second area 103(between lines 161 and 162) while maintaining second portions of bone toprovide the projections 104 that are configured to interact with theconstraint structure 107 of the prosthetic device 90.

The resulting bone cutting pattern (or patterns) is shown in FIG. 2 c.This bone cutting pattern is designed to provide the pocket 106 with theprojections 104 extending toward the center of the pocket 106. Boneresection can then be carried out based on this bone cutting pattern toachieve the pocket 106 with projections 104, as shown in FIG. 2 d.

As shown in FIG. 2 e, the prosthetic device 90 can then be disposed inthe pocket 106. The projections 104 preferably engage the prostheticdevice 90 such that a compressive force is provided between theprosthetic device 90 and the projections 104 such that the location andposition of the prosthetic device 90 can be established in the tibia 100with a relatively high degree of accuracy and precision. The projectionscan be provided to minimize or prevent unwanted movement of a prostheticdevice, such as unwanted translation or rotation of a prosthetic device.Furthermore, the projections can provide real-time cues to apractitioner when a trial or final prosthetic device is in place, suchas audial, visual, or tactile cues.

Due to the engagement of a prosthetic device with the projections whenthe prosthetic device is inserted into a location into bone, an audiblesound can be produced, similar to a part “snapping” into place, theengagement between the prosthetic device and the bone can be visuallychecked, and a practitioner can feel how snugly the engagement betweenthe prosthetic device and the projections is. Thus, configuration of theprosthetic device and the engagement of the prosthetic device with theprojections provides a practitioner with enhanced confidence that theprosthetic device has been located and positioned closely to a surgicalplan.

Such a pocket 106 can be formed to accommodate bone cement or otherjoining substance (referred to generally as adhesive). In particular, anexpansion gap 105 can be maintained between the prosthetic device 90 andthe surface of the tibia 100 so that the adhesive can flow into theexpansion gap 105 to partially or fully fill the expansion gap 105 toassist in the fixation of the prosthetic device 90 to the tibia 100.

The size and location of the projections 104 can be controlled toprovide optimal location and positioning of a prosthetic device. Asshown in the examples of FIGS. 1-2 e, a tibia 100 preferably is preparedto provide four projections 104.

However, fewer projections can be provided. FIGS. 3 a-3 c show anembodiment of a portion of a tibia 110 that has been prepared byresecting bone to provide a pocket 116 that receives a prosthetic devicein a similar manner as the previous embodiment. The embodiment of FIGS.3 a-3 c has only three bone projections 114 that can engage with aprosthetic device 118 instead of four bone projections.

The bone projections 104, 114 can be provided at various locations toaid in locating and positioning a prosthetic device 90, 118 in the tibia100, 110. The location of such projections can be selected based upon,for example, the number of the bone projections. For example, a greaternumber of bone projections can permit a smaller distance between boneprojections in relation to an implantation surface of a prostheticdevice, such as a circumferential surface of a prosthetic device. Othernumbers of bone projections can be provided, such as, for example, five,six, or more bone projections, which can be selected to affect thedistribution of compressive forces between a prosthetic device and abone and to affect the amount of expansion gap provided between theprosthetic device and the bone. For example, the number of projectionscan be selected to provide an advantageous distribution of forcesbetween a prosthetic device and a bone, such as by selecting a greaternumber of projections and a prosthetic device configured to engage suchprojections, but a larger-sized expansion gap, which provides enhancedjoining of the prosthetic device to a bone via bone cement or otherfixation substances, indicates a smaller number of projections. Thus,various considerations must be accounted for when determining whichprosthetic device to use and the number and size/shape of projectionsselected.

Preferably the projections are configured to extend along at least 1% ofthe circumferential perimeter 161 of the pocket and not more than 75% ofthe circumferential perimeter 161 (see FIG. 2 b). Or more particularly,the horizontal length of a prepared anatomical structure can extendbetween 10% and 50% of the circumferential perimeter 161, or moreparticularly 20% and 35% of the circumferential perimeter 161.

In addition, the size and location of bone projections can be controlledto affect the compressive force provided between the bone projectionsand a prosthetic device and to maximize the amount of bone tissue thatis preserved. The durability of the bone projections and the prostheticdevice can be optimized by controlling the size and location of boneprojections. For example, the forces between a prosthetic device and abone can be distributed and optimized by selecting the configuration ofthe prosthetic device and the number and/or size of the projections thatengage the prosthetic device, thus minimizing or preventing unwanteddamage or failure of the prosthetic device or areas of bone, such as theprojections.

Bone projections can have various geometries, such as, for example,spheres, cylinders, cones, elliptical tracks, or other geometricalshapes. In another example, the bone projection can essentially form anegative mold of a mating surface of a prosthetic device or a cavity orindentation in bone that substantially matches the shape of a matingsurface of a prosthetic device. Such bone projections can be threedimensional or two dimensional in form.

The orientation of bone projections can also be altered to affect theengagement between a prosthetic device and a bone. As shown in theexample of FIG. 4, bone projections 122 can be provide in a bone 120such that the bone projections 122 extend in a vertical directionrelative to the bone 120. In another example, bone projections 126 canbe prepared in a bone 124 such that the bone projections 126 extend in asubstantially horizontal direction relative to the bone 124, as shown inthe example of FIG. 9.

In addition, the shape and size of the bone projections can be alteredand selected to affect the engagement between a prosthetic device and abone. The proper size of the bone projections is important not only forthe final location and positioning of a prosthetic device but also forthe easy insertion and removal of a trial prosthetic device during animplantation procedure so that the constraint of the prosthetic devicein a bone may be assessed before final implantation. Further, theselection of the size and shape of the bone projections can affect thelocation of the bone projections. Thus, the prosthetic devices andmethods described herein advantageously assist in the location andpositioning of trial prosthetic devices and prosthetic devices that arefinally implanted and fixed to bone so that the outcome of a surgicalprocedure may be even closer to a surgical plan.

FIG. 5 a shows a perspective view of an exemplary circumferentialperimeter of a pocket 134 prepared in a bone 136, as shown the exampleof FIG. 5 b. As shown in the example of FIGS. 5 a and 5 b, theprojections formed from the bone 136 can have a shape that projects intothe pocket 134 such that the projections form a constraining face 130that engages with the features of a prosthetic device. The projectionscan be shaped to have curved regions 132, such as on lateral sides oredges of the constraining faces 130 of the projections. Such curvedregions 132 can be utilized to increase the size of the projections toincrease the amount of force the projections may withstand when engagingwith a prosthetic device. The shape of the curved region may be selectedto avoid sharp corners, which can act as stress risers or multipliersthat can lead to damage of projection or joint between a prostheticdevice and a bone. In addition, the corners 138 of the pocket can beadvantageously shaped to avoid sharp corners and to affect the expansiongap provided between a prosthetic device and the bone, as shown in FIG.5 c, which shows a corner within an exemplary pocket 139, and as shownin FIG. 5 d, which shows the circumferential perimeter of the pocket139, including a corner 138.

FIG. 6 a shows a perspective view of an exemplary projection 140 formedon a surface 142 of a bone such that the projection 140 extends into apocket 144 formed within the bone. FIG. 6 b shows a top view of theprojection of FIG. 6 a, FIG. 6 c shows a side view of the projection ofFIG. 6 a, and FIG. 6 d shows a front view of the projection of FIG. 6 a.As shown in the examples of FIGS. 6 a-6 d, the projection 140 can have aconstraint surface 146 that is configured to engage with a prostheticdevice. The constraint surface 146 can have a size selected to maximizeengagement between a prosthetic device and the projection 140, and thusminimize or prevent unwanted movement of the prosthetic device, but alsoto provide a properly sized expansion gap between the prosthetic deviceand the bone to also constrain the prosthetic device. For example, sucha constraint surface 146 preferably can have a width X of 1 to 15 mm, 1to 10 mm, 2 to 8 mm, 2 to 5 mm, 2 to 3 mm, or 2 mm or 3 mm, in order ofpreference. In another example, the constraint surface can project fromthe surrounding surface of bone by a distance of 0.01 to 10 mm, 0.1 to 5mm, 0.25 to 2 mm, 0.5 to 1 mm, in order of preference.

The vertical length of a projection may also be varied to control theengagement between a prosthetic device and bone, the amount of expansiongap, and the amount of bone tissue retained during preparation. As shownin the example of FIG. 7 a, a projection 140 can have a vertical heightL1 relative to the total depth L2 of a pocket provided within a bone.Such a vertical height L1 of a projection 140 can be expressed as aratio of the vertical height L1 of the projection 140 to the total depthL2. Projections can be prepared such that the projections have avertical height ratio of 5 to 100%. FIG. 7 b shows an example of aprojection 140 with a vertical height L1 that extends 100% of the totaldepth L2 of a pocket. In another example, projections can have avertical height ratio of 10 to 90%, 20 to 80%, 25 to 45%, or 40%, inorder of preference. Alternatively, the vertical height of a projectioncan be expressed in terms of a ratio of the vertical height of theprojection to a height of a prosthetic device. For example, projectionscan have a vertical height ratio of 10 to 90%, 20 to 80%, 25 to 45%, or40%, in order of preference. In another example, each projection can besized to have a ratio of projection area to total area of 1 to 99%, 5 to90%, 5 to 80%, 10 to 50%, 15 to 30%, in order of preference.

The prosthetic device and projections are preferably sized to provide aninterference fit or press fit between the constraint features of theprosthetic device and the projections. FIG. 8 a shows a side view of anexemplary interference fit between a prosthetic device 150 and a bone152. Such a prosthetic device 150 can be configured to provide acompliance between the prosthetic device 150 and the bone 152 so thatthe compressive forces produced between the prosthetic device 150 andthe bone 152 may be accommodated by the prosthetic device 150 and thebone 152. Such an interference fit can be created when an implantationsurface 158 of a prosthetic device 150 and the surface 156 of a bone,such as at a projection, are oversized such that the surfaces 158, 156overlap in a spatial region, such as the region 159 indicated in theexample of FIG. 8 a.

As shown in the example of FIG. 8 b, the prosthetic device 150 and thebone 152 can overlap in an interference region 159 over a distance X1,which can be a distance of, for example, 0.25 to 0.75 mm, 0.33 to 0.66mm, 0.40 to 0.6 mm, or 0.5 mm, in order of preference. Alternatively, aprosthetic device and the prepared anatomical structures of a bone canbe configured such that there is an interference fit of 0 mm between theprosthetic device and the bone so that the prosthetic device and bonefit together line to line and substantially without spatial overlap. Thesurface 156 of a bone 152 can be shaped to accommodate and distributecompressive forces provided between the bone 152 and a prosthetic device150. For example, the surface 156 of the bone 152 that engages with aprosthetic device 150 can have a rounded or a flat shape.

A prosthetic device and the bone projections can be designed so thatcompressive forces provided between the prosthetic device and the bonenormally remain with a desired range. The following formulas can beutilized when designing a prosthetic device and any prepared anatomicalstructures:

σ_(A) =F/A,

σ_(A) =E·ε,

where σ_(A) represents a stress applied to a given area, F represents aforce applied to that area, A represents the amount of the area, Erepresents the modulus of the material, and represents an amount ofstrain induced in the material. The amount of stress induced in aprosthetic device or bone can also be a function of whether a preparedanatomical feature in a bone is a temporary feature, such as a featureused during trials of a prosthetic device, or a permanent preparedanatomical feature. For example, if a prepared anatomical feature isprovided as a permanent feature, a prosthetic device and the preparedanatomical feature can be designed such that σ_(A) is less than σ_(b),which represents the yield strength of the bone. In another example, theprosthetic device and the prepared anatomical feature can be designedsuch that σ_(A) is greater than 0.1 σ_(b) and less than 0.8 σ_(b), orgreater than 0.3 σ_(b) and less than 0.7 σ_(b). Conversely, if aprepared anatomical feature of a bone is a temporary feature aprosthetic device and the prepared anatomical feature can be designedsuch that σ_(A) greater than or equal to σ_(b). More particularly, theprosthetic device and the prepared anatomical feature can be designedsuch that σ_(A) is less than or equal to 0.5 σ_(b).

The circumferential length prepared anatomical features can be selectedto maximize engagement between a prosthetic device and the preparedanatomical features, and thus minimize or prevent unwanted movement ofthe prosthetic device, but also to provide a properly sized expansiongap between the prosthetic device and a bone to also constrain theprosthetic device with bone cement or another joining substance providedin the expansion gap.

Although the above examples relate to prosthetic devices for a tibia,the present invention also can be applied to other bones and joints,such as a hip joint. FIG. 10 is a cross sectional view of a femur 300that has been prepared to provide a pocket for a prosthetic device 302,i.e., a femoral stem, which has been inserted into an opening formed inthe cortical bone 305 of the femur 300. The prosthetic device 302 caninclude a body portion 301. According to another example, the prostheticdevice can be a hybrid system that includes a plastic centralizer,although one is not required for the present invention. For example, theprepared anatomical structures of the femur 300 can be sufficient toprovide a desired angle for the prosthetic device 302 without additionalcomponents or features to provide a varus/valgus angle that is accurateand close to a surgical plan.

The pocket of the femur 300 can be prepared to provide an expansion gapbetween the prosthetic device 302 and the femur 300 for bone cement 304or another joining substance. In addition, the femur 300 has beenprepared to provide one or more prepared anatomical structures to engagewith the prosthetic device 302.

As shown in FIG. 11 a, which is a cross sectional view along line A-A inFIG. 10, and in FIG. 11 b, which is a cross sectional view along lineB-B in FIG. 10, the prepared anatomical structures can be provided asprojections 306 that extend from a surface of the femur 300 and engagethe prosthetic device 302, such as a constraint structure 307 on animplantation surface 301 of the prosthetic device 302. The projections306 can be configured to engage with the prosthetic device 302 toprovide a compressive force between the projections 306 and theprosthetic device 302. For example, the prosthetic device can includeplurality of projections that project from a lateral side portion of animplantation surface of the prosthetic device. According to anotherexample, the projections can extend vertically, as shown in the exampleof FIGS. 10-11 b and/or can extend along a circumferential perimeter ofthe pocket provided with the femur 300, as discussed in regard to theexamples herein. As shown in the examples of FIGS. 11 a and 11 b, theprojections 306 can be provided as three projections or four projectionsthat engage a surface of the prosthetic device 302. In another example,five or more projections can be provided. The projections 306 can beused to center the prosthetic device 302 within the pocket of the femur300 while providing an expansion gap for the bone cement 304 or otherjoining substance.

The bone projections described above preferably are permanent, i.e.,they remain substantially intact after the prosthetic device has beenfully implanted in the pocket. However, it is not required that the boneprojections be permanent. They instead could be temporary. For example,the bone projections could be utilized during a particular phase ofsurgery to position the prosthetic device and thereafter eliminated,e.g., crushed. As a specific example, the bone projections could be usedto achieve initial positioning of the prosthetic device and when asurgeon drives the prosthetic device into a final implanted position,such as through an impact force, the bone projections could beconfigured to be crushed to allow the prosthetic device to move intothat final implanted position. As a further alternative, the boneprojections could be used to position a trial prosthetic device and thenbe crushed when the permanent prosthetic device is implanted.

Creating Bone Projections that Project into Recesses in ProstheticDevice

Another implementation of the planning method includes defining the bonecutting pattern for removing a first portion of bone in the first areasufficient to seat a body portion of the prosthetic device and formaintaining a portion of the second portion of bone in the second areato provide a projection that is configured to project into a recess inthe prosthetic device forming at least a portion of the constraintstructure.

In this embodiment, the pocket in the bone can be formed by a processsimilar to that described above. However, the bone surface can beprepared to provide projections that interact with a constraintstructure, i.e., a recess, of a prosthetic device.

FIG. 12 a shows a cross-sectional view of an exemplary prosthetic device50 as the prosthetic device 50 is being implanted into a bone 60. FIG.12 b shows the prosthetic device 50 in an advanced stage of implantationinto the bone 60, and FIG. 12 c shows the prosthetic device 50 afterimplantation into the bone 60.

As shown in the example of FIG. 12 a, the prosthetic device 50 caninclude an implantation surface 58 and a constraint structure thatincludes a first projection 54 and a second projection 56 that projectfrom the implantation surface 58 of the prosthetic device 50 in alateral direction, as indicated by arrow L in the example of FIG. 12 c,to form a recess 52. The first projection 54 and the second projection56 can each be a single, continuous projection extending around at leasta portion of the circumference of the prosthetic device 50 or includeplural, discrete projections dispersed around the circumference of theprosthetic device 50. Similarly, the recess 52 can be a single,continuous channel extending around the circumference of the prostheticdevice 50 or be a plurality of discrete channels dispersed around thecircumference of the prosthetic device 50.

As shown in the examples of FIGS. 12 a-12 c, the recess 52 can receiveand engage a projection 62 of the bone 60 to constrain the prostheticdevice 50. Providing such an engagement between the prosthetic device 50and the bone 60 permits a practitioner to “snap” the prosthetic device50 in place, providing confidence that the prosthetic device 50 has beenimplanted substantially according to a surgical plan while minimizing orpreventing unwanted movement of the prosthetic device 50.

The bone 60 can have one or more bone projections 62 that engage withthe prosthetic device 50. The bone projection 62 can be a single,annular bone projection 62 that extends along a portion or entirety ofthe circumference of the prosthetic device 50 or be plural, discretebone projections 62 dispersed along the circumference of the prostheticdevice 50.

The recess 52 also can serve as a side cement channel that is partiallyor fully filled with bone cement or other fixation substances duringimplantation of the prosthetic device 50.

FIG. 13 shows an example of a prosthetic device 20, i.e., a tibialinlay, for implantation into a tibia, such as in the examples discussedimmediately above. As shown in the example of FIG. 13, the prostheticdevice 20 can include a body portion 22 for attachment to a bone and animplantation surface 24 that is configured to face the bone uponimplantation of the prosthetic device 20. The prosthetic device 20 caninclude a constraint structure that enhances the location andpositioning of the prosthetic device 20 during implantation. In theexample shown in FIG. 13, the prosthetic device 20 can include a firstprojection 26 as a constraint structure. The first projection 26 canproject in a lateral direction of the body portion 22 from theimplantation surface 24 of the prosthetic device 20 so that the firstprojection 26 is configured to engage with a bone portion, such as arecess or projection of bone. The prosthetic device 20 may furtherinclude a second projection 28, as shown in the example of FIG. 13 andFIG. 14, which is a side view of the prosthetic device 20 shown in FIG.13. The second projection 28 may serve as a constraint structure,alternatively or in addition to the first projection 26 because thesecond projection 28 may also project in a lateral direction of the bodyportion 22 from the implantation surface 24 of the prosthetic device 20so that the second projection 28 is configured to engage with theprepared features of a bone, such as a recess or channel shaped toreceive the second projection 28.

The second projection 28 can have a shape that is matched to theinstruments used to prepare a bone surface. For example, the secondprojection 28 can have an edge radius that is matched to a size of aninstrument used to prepare a bone surface, such as a radius of a burr,such as, for example a 6 mm burr. According to another example, theprosthetic device 20 can be configured such that all features of theprosthetic device 20 correspond to a minimal number of instruments tofacilitate bone preparation. For example, the prosthetic device 20 canbe configured such that a single burr, such as, for example, a 6 mmburr, can be used to prepare a bone for the prosthetic device 20.

The prosthetic device 20 can include a recess 30, as shown in theexamples of FIGS. 13 and 14. The side recess 30 can be formed as arecess in the implantation surface 24 that provides a space for bonecement or another joining substance so that a relatively large fixationforce can be provided between the prosthetic device 20 and the bone thatthe prosthetic device 20 is implanted into. Therefore, the prostheticdevice 20 can have a pullout strength that is comparable to that ofonlay designs. Such a side recess 30 can have a size of, for example,0.25 to 10 mm, 0.25 to 5 mm, 0.5 to 3 mm, 1 to 2 mm, in order ofpreference. In the opposing direction, the same size can be applied. Theshape of the form can be rectangular, circular, dovetail, cylindrical,arcuate, corrugated, or other appropriate forms, such as those thatcould by made by a tool such as a router.

The prosthetic device 20 can include one or more x-ray marker pins 34 toassist in the location and positioning of the prosthetic device 20during implantation. In addition, a bottom surface of the prostheticdevice 20 can include a recess 38, as shown in the example of FIG. 15,which shows a cement pocket in the form of the letter D.

FIG. 16 a shows a cross-sectional view of another exemplary prostheticdevice 70 as the prosthetic device 70 is being implanted into a bone 80.FIG. 16 b shows the prosthetic device 70 in an advanced stage ofimplantation into the bone 80 and FIG. 16 c shows the prosthetic device70 after implantation into the bone 80.

In the example shown in FIGS. 16 a-16 c, the prosthetic device 70includes an implantation surface 72 and a constraint structure. Theconstraint structure can be formed by a projection 74 projecting fromthe implantation surface 72 of the prosthetic device 70 to form a recessin a side of the prosthetic device 70. Such a projection 74 can be asingle, continuous projection extending around at least a portion of thecircumference of the prosthetic device 70 or include plural, discreteprojections dispersed around the circumference of the prosthetic device70. Such a projection 74 can engage with the bone 80 to constrain theprosthetic device 70, thus aiding in fixing the prosthetic device 70 tothe bone 80 and minimizing or preventing unwanted movement of theprosthetic device 70.

The bone 80 can include a bone projection 82, which can be a single,continuous projection extending around at least a portion of acircumference of a cavity formed in the bone 80 for the prostheticdevice 70 or can include a plurality of discrete projections dispersedabout the circumference of the cavity in the bone 80. As shown in theexamples of FIGS. 16 a-16 c, the projection 82 can form a recess 84,which can accommodate the projection 74 of the prosthetic device 70.Thus, the projection 74 can be configured to engage with the bone 80 atthe recess 84 such that the prosthetic device 70 is constrained.Similarly, the bone forms a projection that extends into the recessformed by the projection 74.

FIG. 17 a shows an example of a bone 170 with a prepared pocket 172. Thebone 170 includes projections 174 formed from the bone and providedwithin the pocket 172. As shown in FIG. 17 b, which is a cross sectionalview along line A-A in FIG. 17 a, the projections 174 can extendvertically into the pocket 172 from a bottom surface of the preparedpocket 172. Such projections 174 can be inserted into correspondingrecesses or holes in a prosthetic device to center, locate, and positionthe prosthetic device within the pocket 172 and to minimize or preventunwanted movement of the prosthetic device.

FIG. 18 a is a top view of an exemplary prosthetic device 180 that canbe used with the prepared bone of FIGS. 17 a and 17 b. As shown in FIG.18 b, which is a cross sectional view along line B-B of FIG. 18 a, theprosthetic device 180 can include recesses or holes that receive thebone projections 174 of bone 170. The prosthetic device 180 can alsoinclude a channel or undercut 184 within the bone projections to providean expansion gap or space for bone cement or other fixation substance.

The recesses prepared in a bone and the constraint structures can alsobe configured to interlock with one another to constrain the prostheticdevice. For example, FIG. 19 a is a top view of a prosthetic device 200and a bone 202 that has been prepared to include one or more interlockprojections 204. As shown in FIG. 19 b, which is a cross-sectional viewalong line B-B of FIG. 19 a, the interlock projections 204 can extendvertically upwards from the bone 202, and the prosthetic device 200 caninclude one or more recesses or channels 206 configured to receive theinterlock projections 204, such as by sliding the prosthetic device 200onto the bone in the direction indicated by arrow S in FIG. 19 a. Thechannels 206 can have a shape that is matched to the shape of theinterlock projections 204, as shown in the example of FIGS. 19 a and 19b. In another example, the bone projections 204 can have a dovetailshape or other shape to promote interlocking between a prosthetic deviceand bone.

The recesses or channels 206 in the implantation surface of theprosthetic device 200 can be configured to receive bone to constrain thebody portion of the prosthetic device 200 in at least two translationaldegrees of freedom. For example, the recesses or channels 206 can beconfigured constrain the prosthetic device 200 in directions normal tothe sliding direction indicated by arrow S in the example of FIG. 19 a.

The recesses or channels 206 can include at least one sidewall 221 withportions for engaging bone to constrain the body portion of a prostheticdevice 200 in at least two translational degrees of freedom. Forexample, the recesses 206 can include an inner surface 205 and a recesssurface 207, with the recess surface 207 disposed between the innersurface 205 and a proximal portion 203 of an implantation surface of theprosthetic device 200 so as to form a space 209 for receiving aninterlock-projection surface of the interlock projection 204 of the bonebetween the recess surface 207 and the inner surface 205. The recesssurface 207 preferably includes a substantially planar portion 211 thatextends at an obtuse angle relative to the proximal portion 203 of theimplantation surface. In another example, the interlock projection 204includes an additional interlock-projection surface that contacts anadditional recess surface 225 configured to receive bone in a spacebetween the additional recess surface 225 and the inner surface 205. Inanother example, the recess surface 207 can include a substantiallyarcuate portion. In another example, a recess or channel can include anadditional recess surface configured to form a space for receiving bonebetween the additional recess surface and the inner surface of therecess or channel.

FIG. 20 shows a cross-sectional view of an exemplary prosthetic device36 that can be used with the method shown in FIGS. 19 a and 19 b. Asshown in FIG. 20, the prosthetic device can include one or more recesses38 on a bottom surface of the prosthetic device 36. The recess 38 can beconfigured to accommodate bone cement or another joining substanceduring implantation of the prosthetic device 36 to enhance location andpositioning of the prosthetic device 36. Thus, the recess 38 may serveas a constraint structure of the prosthetic device 36, with the bottomsurface of the prosthetic device 36 serving as an implantation surface.Such a recess 38 can be partially or fully filled with bone cement oranother joining substance during implantation of the prosthetic device36.

The prosthetic device 36 can have one or more x-ray marker pins 42.Further, the prosthetic device 36 can include a recess or side cementchannel 44, such as the recess discussed above, in addition to therecess 38. Such a recess 44 can be formed by one or more projections, asdiscussed herein.

In another example, this method can also be applied to a femur. FIG. 21a shows a femur 290 that has been prepared to provide a pocket 291 toreceive a prosthetic device. The pocket 291 has been selectivelyprepared to provide a prepared anatomical structure 292 that isconfigured to engage with the prosthetic device to locate and positionthe prosthetic device so that unwanted movement of the prosthetic deviceis minimized or prevented. Such a prepared anatomical structure 292 canbe a projection extending from a surface of the femur 290, as shown inthe example of FIG. 21 a.

FIG. 21 b shows a side cross sectional view of the femur 290 of FIG. 21a. As shown in FIG. 21 b, the femur can be prepared to provide aplurality of prepared anatomical structures 292 to engage with aprosthetic device, such as the device 294 of FIG. 22, which includes oneor more constraint structures, such as projections 296, to engage withthe anatomical structures 292. The prosthetic device 294 can include oneor more constraint structures 296, as shown in the example of FIG. 22.The constraint structure 296 can be a projection extending from asurface of the prosthetic device, as discussed in regard to the examplesherein. Such projections can engage with a femur to provide acompressive force between the femur and the prosthetic device. Theprosthetic device can be a total knee prosthetic device, as shown in theexample of FIG. 22, or can be a unicompartmental prosthetic device or asegment of a total knee or unicompartmental prosthetic device.

The prepared anatomical structures 292 can be a plurality of recesses orchannels configured to receive and engage with the features of theprosthetic device. The prepared anatomical structures 292 can bediscrete structures, as shown in the example of FIG. 21 b, or be asingle, continuous structure. The prepared anatomical structures canextend in an anterior-posterior direction, as shown in the example ofFIG. 21 b.

This method can also be applied to acetabular hip prosthetic devices. Intotal hip arthroplasty the acetabulum receives a cup that is typicallyspherical in form. In an impaction technique the cup is pressed into aslightly undersized mating form. However, due to the shape of the cupinclination and/or abduction can occur, causing implantation to possiblydeviate from a surgical plan.

FIG. 23 a shows an example of a portion of hip bone 310 that includes aprepared pocket 312 for a prosthetic device. The hip bone 310 can beprepared to include prepared anatomical structures to engage with theprosthetic device and provide compression forces between the hip boneand the prosthetic device. For example, the prepared anatomicalstructures can be projections 314, as shown in the example of FIG. 23 a.

A prosthetic device 316 can be configured to include a constraintstructure, such as a projection and/or recess 318, that engages with theprepared anatomical structures of the hip bone 310, as shown in theexample of FIG. 23 b, which shows the prosthetic device as it is beinginserted into the pocket 312 of the hip bone 310. FIG. 23 c shows theprosthetic device 316 after implantation is complete. According to anexample, an end 317 of the prosthetic device 316 can engage with one ormore of the projections 314 of the hip bone 310, as shown in FIGS. 23 band 23 c. According to another example, the prosthetic device includesat least one recess 319 that includes a sidewall 313 with at least twoportions for engaging the hip bone 310 to constrain a body portion ofthe acetabular cup in at least two translational degrees of freedom.

By providing the constraint structures in the prosthetic device 316 andthe prepared anatomical features in the hip bone 310, the prostheticdevice 316 can be located and positioned in the hip bone with minimal orno deviation from a surgical plan due to unwanted movement of theprosthetic device 316. In addition, the constraint structures in theprosthetic device 316 and the prepared anatomical features in the hipbone 310 can provide a controlled placement of the prosthetic device 316within the hip bone 310, thus increasing confidence that implantation ofthe prosthetic device 316 has occurred according to a surgical plan.

Creating Bone Recess to Receive Projections from Prosthetic Device

Another implementation of the planning method includes defining the bonecutting pattern for removing a first portion of bone in the first areasufficient to seat a body portion of the prosthetic device and forremoving a portion of the second portion of bone in the second area toprovide a recess that is configured to receive a projection from theprosthetic device forming at least a portion of the constraintstructure. For example, a constraint structure of a prosthetic devicecan include at least one interlock projection projecting from animplantation surface and having an interlock-projection surfaceconfigured to receive bone in a space between the interlock-projectionsurface and a proximal portion of the implantation surface.

FIG. 24 a is a top view of a prosthetic device 210 and a bone 212 thathas been prepared to include one or more recesses or channels 214,according to another example. The prosthetic device 210 includes one ormore interlock projections 216 that project from an implantation surface215 of the prosthetic device 210. As shown in FIG. 24 b, which is across sectional view along line C-C of FIG. 24 a, the interlockprojections 216 of the prosthetic device 210 can be inserted into thechannels 214 of the bone 212, such as by sliding the prosthetic device210 towards the bone 212 from a lateral side of the bone 212, asindicated by arrow S in FIG. 24 a. As shown in the example of FIGS. 24 aand 24 b, the prosthetic device 210 can be configured to include aninterlock-projection surface 217 that is configured to receive bone in aspace 219 between the interlock-projection surface 219 and a proximalportion 213 of the implantation surface. The interlock-projectionsurface 217 can include a substantially planar portion 229 that extendsover the proximal portion at an acute angle relative to the proximalportion 213 of the implantation surface. The interlock-projectionsurface 219 can alternatively include a substantially arcuate portion227.

FIG. 25 a is a top view of a prosthetic device 194 and a bone 190 thathas been prepared to include one or more recesses or channels 192,according to another example. The prosthetic device 194 includes one ormore interlock projections 196 that project from an implantation surface198 of the prosthetic device 194. For example, the interlock projections196 can project from a bottom side portion 223 of the implantationsurface 198. As shown in FIG. 25 b, which is a cross sectional viewalong line A-A of FIG. 25 a, the interlock projections 196 of theprosthetic device 194 can be inserted into the channels 192 of the bone190, such as by sliding the prosthetic device 194 towards the bone 190from a lateral side of the bone 190, as indicated by arrow S in FIG. 25a. Thus, the interlock projections 196 and the channels 192 can locateand position the prosthetic device 194 relative to the bone 190 suchthat unwanted movement of the prosthetic device 194 is minimized orprevented. The interlock projections 196 and the channels 192 can havedovetail shapes, as shown in the examples of FIGS. 25 a and 25 b, orother shapes to promote interlocking between a prosthetic device andbone.

As shown in the example of FIGS. 25 a and 25 b, the prosthetic device194 can be configured to include an interlock-projection surface 197that is configured to receive bone in a space 195 between theinterlock-projection surface 197 and a lower portion 199 of theimplantation surface. The interlock-projection surface 197 can include asubstantially planar portion that projects over and extends at an acuteangle relative to the lower portion 199 of the implantation surface, asshown in the example of FIGS. 25 a and 25 b.

The recesses or channels in the implantation surface of the prostheticdevice can be configured to receive bone to constrain the body portionof the prosthetic device in at least two translational degrees offreedom. For example, the recesses or channels can be configuredconstrain the prosthetic device in directions normal to the slidingdirection indicated by arrow S in the examples of FIGS. 24 a and 25 a.

The recesses or channels and projections described above in regard toFIGS. 24 a, 24 b, 25 a, and 25 b can be used with a bone cement or otherjoining substance to fix a prosthetic device to a bone. Alternativelythese recesses or channels and projections can be used to constrain aprosthetic device in the bone in the absence of bone cement or otheradhesive substance.

FIG. 26 a shows another example of a prosthetic device 328, i.e., anacetabular cup, with a plurality of constraint structures, which can bea plurality of vertically extending projections 330, as shown in FIG. 26a and FIG. 26 b. The projections shown in FIGS. 26 a and 26 b can beconfigured to engage with the prepared anatomical features of hip boneto provide desired positioning between the projections and the preparedanatomical features.

In another example, the recesses or channels can include a sidewall withat least two portions for engaging bone to constrain the body portion ofa prosthetic device in at least two translational degrees of freedom.The recesses or channels can include an inner surface and a recesssurface, with the recess surface disposed between the inner surface anda proximal portion of an implantation surface of the prosthetic deviceso as to form a space for receiving bone between the recess surface andthe inner surface. In another example, the recess surface can include asubstantially planar portion that extends at an obtuse angle relative tothe proximal portion of the implantation surface. For example, therecess surface can be provided in the shape of a dovetail. In anotherexample, the recess surface can include a substantially arcuate portion.In another example, a recess or channel can include an additional recesssurface configured to form a space for receiving bone between theadditional recess surface and the inner surface of the recess orchannel.

Receiving Prosthetic Device Having Compressive Projections

To provide enhanced location and positioning of a prosthetic device in abone, a prosthetic device can include a body portion for attachment to abone that includes an implantation surface configured to face the boneupon implantation and a constraint structure configured to constrain theprosthetic device in the bone. The constraint structure can include atleast one projection that projects from the implantation surface. Such aprojection can project in a lateral direction of the body portion fromthe implantation surface and be configured to provide a compressiveforce between the prosthetic device and the bone. Such projections cancreate a compressive force by causing the projection to be compressed,the bone to be compressed, or both the projection and the bone to becompressed.

FIG. 27 shows an example of a prosthetic device 510 implanted in a bone500, such as a tibia. The prosthetic device 510 includes at least oneconstraint structure, such as a projection 512, that projects from animplantation surface 514 of the prosthetic device 510 to engage asurface of the bone 500 within a pocket prepared within the bone 500,providing a compressive force between the prosthetic device 510 and thebone 500. Such projections 512 can have different sizes and shapes, asdiscussed for the exemplary projections discussed herein, and can beconfigured to provide an interference fit with the bone 500. Byproviding a compressive force between the prosthetic device 510 and thebone 500, the location and positioning of the prosthetic device 510 canbe aided and unwanted movement of the prosthetic device 510 can beminimized or prevented.

The projections described in the various embodiments above preferablyare permanent, i.e., they remain substantially intact after theprosthetic device has been fully implanted in the pocket. However, it isnot required that the projections be permanent. They instead could betemporary. For example, the projections could be utilized during aparticular phase of surgery to position the prosthetic device andthereafter eliminated, e.g., crushed. As a specific example, theprojections could be used to achieve initial positioning of theprosthetic device and when a surgeon drives the prosthetic device into afinal implanted position, such as through an impact force, theprojections could be configured to be crushed to allow the prostheticdevice to move into that final implanted position.

Providing Projections for Positioning of Prosthetic Device

According to another example, a bottom surface of a pocket preparedwithin a bone can include a prepared anatomical structure that aprosthetic device is configured to engage such that the prostheticdevice is constrained to minimize unwanted movement. As shown in theexample of FIG. 28 a, a pocket 252 can be prepared in a bone 250 and atleast one projection 254 can be formed on a bone surface 256 of thepocket 252. The projection 254 can be prepared by selectively removingand maintaining bone tissue to provide a projection 254 that extendsvertically into the pocket 252. The projection 254 can be a singleprojection in the shape of a cross, as shown in the example of FIG. 28a, or be one or more discrete projections with various shapes.

A projection 254 can be used to control the depth to which a prostheticdevice is inserted into the pocket 252. For example, the height of theprojection 254 can be designed to control the depth of the prostheticdevice within the pocket 252 and/or to control an expansion gap for bonecement or other joining substance between the prosthetic device and thebone 250. Thus, the prosthetic device can sit or be placed on top of oneor more projections 254 within the pocket 252. In a further example, theprojections 254 can permit a practitioner to prepare the pocket 252 inless time because the top engaging surfaces of the projections 254 couldbe prepared with relatively high precision while the remaining portionsof the bottom surface 256 could be prepared with less precision,permitting the preparation of the pocket 252 to be accomplished in lesstime. In addition, by providing one or more projections 254 to engagewith and support a prosthetic device, any asperities that wouldotherwise be present in the bottom surface 256 and their effects on thelocation and positioning of a prosthetic device are avoided bysupporting the prosthetic device above the bottom surface 256 on theprojection 254.

FIG. 28 b shows another example of a pocket 262 prepared in a bone 260.The bone 260 has been selectively prepared to provide a single,continuous, annular projection 264 that extends around a circumferentialperimeter of the bottom surface 266 of the pocket 262. Such a projection264 can be used to engage with and support a prosthetic device, asdiscussed above in regard to the example of FIG. 28 a.

FIG. 28 c shows another example of a pocket 272 prepared in a bone 270.The bone 270 has been selectively prepared to provide a plurality ofprojections 274 that extend vertically upwards from a bottom surface 276of the pocket 272. Such projections 274 can engage with and support aprosthetic device, as discussed above in regard to the example of FIG.28 a. The projections 274 can have a top surface 278 that issubstantially flat, slightly rounded, or other shapes to facilitateengagement between the prosthetic device and the projections.

FIG. 29 a shows an example of a prosthetic device 320, i.e., anacetabular cup, that includes a plurality of constraint structures. Asshown in the example of FIG. 29 a, the constraint structures can be aplurality of projections 322 that extend radially along the outersurface of the prosthetic device 320. Such projections can be configuredto provide a desired position between the prosthetic device and the bonethat the prosthetic device engages. FIG. 29 b shows an example of aprosthetic device 324 that includes a plurality of horizontally orientedconstraint structures, such as projections 326.

According to another example, prepared anatomical structures can be usedto aid in the location and/or positioning of prosthetic devices duringimplantation in bone. Such prepared anatomical structures can be used tohelp locate and/or position one or more surfaces of a prosthetic device,such as a primary datum surface, secondary datum surface, and/ortertiary datum surface. For example, the bone preparation techniquesdescribed herein can be used to provide geometric landmarks in thepelvic region. Such geometric landmarks can assist in the implantationof a prosthetic device. For example, prepared anatomical structures canprovide geometric landmarks in the pelvic region that serve asreferences that provide positioning information of the pelvis duringimplantation of a prosthetic device. In another example, selectiveremoval or non-removal of bone can be implemented to provide preparedanatomical structures and a prosthetic device can have correspondingfeatures, such as surfaces, projections, or recesses, that engage withor mate with the prepared anatomical structures. Both types of preparedanatomical features can provide better positioning of a prostheticimplant and visual verification of the location of a prosthetic deviceby surgeon, thus increasing confidence that implantation of a prostheticdevice has been fully successful.

The prepared anatomical structures, such as bone projections, discussedherein can be also be used to locate or position an instrument insteadof, or in addition to, a prosthetic device. For example, preparedanatomical structures, such as bone projections, can be used as visualcues when orienting and positioning a tibial baseplate that includes akeel that must be accurately inserted into a tibia. The preparedanatomical structures can also engage with or mate with instruments thatguide and/or place a prosthetic device, such the tibial baseplate with akeel.

Robotic System

The planning methods and prosthetic devices described herein do notrequire the use of a robotic system. For example, jigs or similarguiding instruments can be used to assist in the preparation of bone.However, a robotic system for preparing a bone to receive a prostheticdevice can be particularly beneficial for practicing the planningmethods and implanting the prosthetic devices. For example, it canincrease the accuracy and precision of bone preparation and the featuresproduced during bone preparation. FIG. 30 shows an example of apreferred haptic robotic system 600. Such a robotic system 600 isdescribed in Published U.S. Patent Application Pub. No. 2009/0000626,which is hereby incorporated herein by reference in its entirety.

The robotic system 600 preferably includes a controllable guidestructure configured to guide cutting of the bone into a shape forreceiving the prosthetic device. The controllable guide structure caninclude, for example, a robotic arm 610. The robotic arm 610 isconfigured to guide a surgeon to control the resection of bone. As shownin the example of FIG. 30, the robotic arm 610 of the robotic system canbe used to operate on a leg L, which includes a femur F, and a tibia T,although the robotic system 600 can be used on other bones and joints.

The robotic system 600 can include a computer 620. The computer 620 canhave a computer readable medium for storing data representative of theprosthetic device. The computer 620 also can form at least part of acontrol system for controlling the guide structure, e.g., robotic arm610.

The control system preferably is configured to define at least onebone-cutting pattern for (i) removing a first portion of bone in a firstarea sufficient to seat the body portion of the prosthetic device and(ii) at least one of removing and maintaining a second portion of bonein a second area configured to interact with the constraint structure.The control system can be configured to define the various bone-cuttingpatterns described above in connection with the planning methods. Forexample, the control system may include planning software andinformation about the geometry of a prosthetic device, surgicalinstruments used, and/or anatomy being prepared, thus providing greatersurgical confidence due to the accuracy and precision of the roboticsystem. The software can permit manipulation of a feature plan, whichcan include information about the location, orientation, size, and/orshape of at least one of the prosthetic device and the anatomy beingprepared so that the feature plan can be personalized for the patientbut in conformance with instruments used and the prosthetic device andits features, including any mating and constraining features of theprosthetic device.

The robotic system 600 also may include a display 630 that is controlledby the control system to display information representative of the atleast one bone-cutting pattern on the display.

Trauma

According to another example, the features of the examples describedherein can be provided to bones that have experienced trauma, such afracture. FIG. 31 a shows a bone 340 undergoing trauma, such as one ormore fractures, causing the bone 340 to be broken into multiple pieces342. Such fractures may require surgery, including reduction andstabilization, such as when a fracture occurs mid-shaft in a femur. Suchsurgery requires proper alignment and orientation of the bone pieces342.

As shown in the example of FIG. 31 a, the bone pieces 342 can beprepared to include prepared anatomical structures 344, such as a recessor channel or a projection, on each bone piece 342 to provide mating,corresponding structures. For example, a first bone piece can beprovided with a recess or channel while a second bone piece that mateswith the first can be provided with a projection that engages with ormates with the recess or channel of the first bone piece. Suchcorresponding bone pieces can be provided with a single pair ofcorresponding structures or a plurality of corresponding structures, asshown in the example of FIG. 31 b, which shows an enlarged portion ofcorresponding bone pieces joined along a fracture line 346. Suchstructures guide joining of the bone pieces and assist in the locationand positioning of the bone pieces relative to one another. In addition,the prepared anatomical structures 344 can serve only as cues to assistin the alignment and positioning of the bone pieces without acting asengagement structures. FIG. 31 c shows various exemplary geometries thatcan be used for the prepared anatomical structures 344, or for otheranatomical structures discussed herein.

FIG. 32 a shows another example of a bone piece 350 that has beenfractured from a bone due to trauma. In this example, the bone piece 350has been prepared to include prepared anatomical structures 352 toengage with a hardware component that assists in joining bone pieces andhealing fractures between the bone pieces. Such prepared anatomicalstructures can be, for example, recesses or channels, as shown in theexample of FIG. 32 a, or projections extending from a surface of thebone piece 350 prepared by the selective preparation of a surface of thebone piece 350. The prepared anatomical structures 352 can be configuredto engage with constraint structures of a hardware component, such as afracture plate 354, as shown in the example of FIG. 32 b. For example,the fracture plate 354 can include projections 356 that can be insertedinto recesses 352 provided in the bone 350, thus guiding insertion andalignment of the fracture plate 354 relative to the bone piece 350.

FIG. 33 shows another example of a bone 360 that has been fractured intomultiple bone pieces B. However, due to surgical preparation of the bonepieces, one piece B may not be suitable for rejoining or a void mayotherwise be created in the assembly of bone pieces B. An additionalpiece HB, such as a harvested bone piece or piece of biocompatiblematerial may be used to replace the missing piece or void and promotehealing of the trauma. The bone pieces B and additional piece HB caninclude prepared anatomical structures and constraint structuresdiscussed in regard to the examples of FIGS. 31 a-32 b to assist in thelocation and positioning of the bone pieces B and the additional pieceHB.

CONCLUSION

The prosthetic devices, systems, and methods described herein can beused in various bones, joints, and surgical techniques. For example, theprosthetic devices, systems, and methods described herein can be used infull or partial knee procedures, hip procedures, or shoulder procedures.In addition, the prosthetic devices, systems, and methods describedherein can be used in spinal procedures, ankle procedures, elbowprocedures, wrist procedures, hand procedures, foot procedures, dentalprocedures, such as maxilla and mandible operations, and traumaprocedures.

The prosthetic devices discussed herein can be fixed to bone with acement or other substance, such as, hydroxyapatite (HA) (collectivelyreferred to as adhesive herein). In another example, the prostheticdevices discussed herein can be fixed to bone via a mechanicalconnection or interlock that does not require a cement or adhesivesubstance. For example, a prosthetic device can include a porous surfacethat has a microscopic texture that mechanically joins to a surface of abone. The features and examples discussed above for hip prostheticdevices can also be applied to shoulder prosthetic devices because theseprosthetic devices and bones have similarities.

The prosthetic devices discussed herein can be made of any suitablematerial, such as, for example, polymer material. The polymer could be,for example, ultra high molecular weight polyethylene (UHMWPE).

Other embodiments of the present invention will be apparent to thoseskilled in the art from consideration of the specification and practiceof the invention disclosed herein. It is intended that the specificationand examples be considered as exemplary only.

1. A prosthetic device for implantation in bone, comprising: a bodyportion for attachment to a bone, wherein the body portion includes animplantation surface configured to face the bone upon implantation; andconstraint structure comprising at least one of: (i) at least onecompressive projection projecting from the implantation surface in alateral direction of the body portion and configured to provide acompressive force between the at least one compressive projection andthe bone, (ii) at least one interlock projection projecting from theimplantation surface and having an interlock-projection surfaceconfigured to receive bone in a space between the interlock-projectionsurface and a proximal portion of the implantation surface, and (iii) atleast one recess in the implantation surface and configured to receivebone to constrain the body portion in at least two translational degreesof freedom, wherein the constraint structure is configured to constrainthe prosthetic device in the bone.
 2. The prosthetic device of claim 1,wherein the at least one compressive projection is configured to includea bone-engaging surface for engaging the bone and a free surface thatdoes not engage the bone.
 3. The prosthetic device of claim 1,comprising at least three compressive projections.
 4. The prostheticdevice of claim 1, wherein the interlock-projection surface includes asubstantially planar portion that projects over and extends at an acuteangle relative to the proximal portion of the implantation surface. 5.The prosthetic device of claim 1, wherein the interlock-projectionsurface includes a substantially arcuate portion that projects over theproximal portion of the implantation surface.
 6. The prosthetic deviceof claim 1, wherein the at least one interlock projection includes anadditional interlock-projection surface configured to receive bone in aspace between the additional interlock-projection surface and a proximalportion of the implantation surface.
 7. The prosthetic device of claim1, wherein the at least one recess includes an inner surface and arecess surface, wherein the recess surface is disposed between the innersurface and a proximal portion of the implantation surface so as to forma space for receiving bone between the recess surface and the innersurface.
 8. The prosthetic device of claim 7, wherein the recess surfaceincludes a substantially planar portion that extends at an obtuse anglerelative to the proximal portion of the implantation surface.
 9. Theprosthetic device of claim 7, wherein the recess surface includes asubstantially arcuate portion.
 10. The prosthetic device of claim 7,wherein the at least one recess includes an additional recess surfaceconfigured to form a space for receiving bone between the additionalrecess surface and the inner surface.
 11. The prosthetic device of claim1, wherein the at least one recess includes a sidewall with at least twoportions for engaging bone to constrain the body portion in the at leasttwo translational degrees of freedom.
 12. The prosthetic device of claim1, wherein the constraint structure is configured to constrain theprosthetic device in the bone in the absence of adhesive.
 13. Theprosthetic device of claim 1, wherein the prosthetic device is one of atibial implant and a femoral implant configured to be implanted in arespective one of a tibia and femur to form a portion of a knee joint.14. The prosthetic device of claim 13, wherein the at least one of thetibial implant and the femoral implant includes a plurality of thecompressive projections projecting from a lateral side portion of theimplantation surface.
 15. The prosthetic device of claim 13, wherein theat least one of the tibial implant and the femoral implant includes theat least one interlock projection projecting from a bottom side portionof the implantation surface.
 16. The prosthetic device of claim 13,wherein the at least one of the tibial implant and the femoral implantincludes the at least one recess in a bottom side portion of theimplantation surface.
 17. The prosthetic device of claim 1, wherein theprosthetic device is an acetabular cup configured to be implanted in apelvis to form a portion of a hip joint.
 18. The prosthetic device ofclaim 17, wherein the acetabular cup includes the at least one recess,wherein the at least one recess includes a sidewall with at least twoportions for engaging bone to constrain the body portion in the at leasttwo translational degrees of freedom.
 19. The prosthetic device of claim1, wherein the prosthetic device is a femoral stem configured to beimplanted in a femur to form a portion of a hip joint.
 20. Theprosthetic device of claim 19, wherein the femoral stem includes aplurality of the compressive projections projecting from a lateral sideportion of the implantation surface.
 21. A method for planning boneremoval for implantation of a prosthetic device into bone, comprising:storing data representative of a prosthetic device in a computerreadable medium, wherein the prosthetic device includes a body portionhaving an implantation surface configured to face the bone uponimplantation and at least one feature that provides a constraintstructure that will constrain the prosthetic device in the bone; anddefining, based on the data, at least one bone-cutting pattern for (i)removing a first portion of bone in a first area sufficient to seat thebody portion and (ii) at least one of removing and maintaining a secondportion of bone in a second area configured to interact with theconstraint structure.
 22. The method of claim 21, wherein the definingof the at least one bone-cutting pattern includes removing a portion ofthe second portion of bone, while maintaining a portion of the secondportion of bone to provide at least one projection configured to engagethe implantation surface to provide a compressive force between theprojection and implantation surface and constrain the prosthetic device.23. The method of claim 22, wherein the defining of the at least onebone-cutting pattern includes maintaining a portion of the secondportion of bone to provide a plurality of projections configured toengage the implantation surface to provide a compressive force betweenthe projection and implantation surface and constrain the prostheticdevice.
 24. The method of claim 21, wherein the defining of the at leastone bone-cutting pattern includes maintaining a portion of the secondportion of bone to provide a projection that is configured to projectinto a recess in the prosthetic device forming at least a portion of theconstraint structure.
 25. The method of claim 21, wherein the definingof the at least one bone-cutting pattern includes removing a portion ofthe second portion of bone to provide a recess that is configured toreceive a projection from the prosthetic device forming at least aportion of the constraint structure.
 26. The method of claim 21, furthercomprising displaying information representative of the at least onebone-cutting pattern.
 27. A robotic system for preparing a bone toreceive a prosthetic device, the robotic system comprising: acontrollable guide structure configured to guide cutting of the boneinto a shape for receiving the prosthetic device; a computer readablemedium for storing data representative of the prosthetic device, whereinthe prosthetic device includes a body portion having an implantationsurface configured to face the bone upon implantation and at least onefeature that provides a constraint structure that will constrain theprosthetic device in the bone; and a control system for controlling theguide structure, wherein the control system is configured to define atleast one bone-cutting pattern for (i) removing a first portion of bonein a first area sufficient to seat the body portion and (ii) at leastone of removing and maintaining a second portion of bone in a secondarea configured to interact with the constraint structure.
 28. Therobotic system of claim 27, wherein the control system is configured todefine the at least one bone-cutting pattern by removing a portion ofthe second portion of bone, while maintaining a portion of the secondportion of bone to provide at least one projection configured to engagethe implantation surface to provide a compressive force between theprojection and implantation surface and constrain the prosthetic device.29. The robotic system of claim 28, wherein the control system isconfigured to define the at least one bone-cutting pattern to maintain aportion of the second portion of bone to provide a plurality ofprojections configured to engage the implantation surface to provide acompressive force between the projection and implantation surface andconstrain the prosthetic device.
 30. The robotic system of claim 27,wherein the control system is configured to define the at least onebone-cutting pattern to maintain a portion of the second portion of boneto provide a projection that is configured to project into a recess inthe prosthetic device forming at least a portion of the constraintstructure.
 31. The robotic system of claim 27, wherein the controlsystem is configured to define the at least one bone-cutting pattern toremove a portion of the second portion of bone to provide a recess thatis configured to receive a projection from the prosthetic device formingat least a portion of the constraint structure.
 32. The robotic systemof claim 27, further comprising a display, wherein the control systemdisplays information representative of the at least one bone-cuttingpattern on the display.